Immunopathogenesis of Eosinophilic Esophagitis

Simon, Hans‐Uwe; Straumann, Alex

doi:10.1159/000357003

Cited by 8 publications

(6 citation statements)

References 31 publications

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“…Tissue remodelling exists in rhinosinusitis . Epithelial barrier and remodelling features close to those of asthma are found in EoE, a Th2 often non‐IgE‐associated disease of an endodermic organ .…”

Section: Importance Of Type 2 Signalling In Inflammation and Remodellmentioning

confidence: 99%

Are allergic multimorbidities and IgE polysensitization associated with the persistence or re‐occurrence of foetal type 2 signalling? The MeDALL hypothesis

Bousquet

Antó

Wickman

et al. 2015

Allergy

105

125

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Allergic diseases [asthma, rhinitis and atopic dermatitis (AD)] are complex. They are associated with allergen‐specific IgE and nonallergic mechanisms that may coexist in the same patient. In addition, these diseases tend to cluster and patients present concomitant or consecutive diseases (multimorbidity). IgE sensitization should be considered as a quantitative trait. Important clinical and immunological differences exist between mono‐ and polysensitized subjects. Multimorbidities of allergic diseases share common causal mechanisms that are only partly IgE‐mediated. Persistence of allergic diseases over time is associated with multimorbidity and/or IgE polysensitization. The importance of the family history of allergy may decrease with age. This review puts forward the hypothesis that allergic multimorbidities and IgE polysensitization are associated and related to the persistence or re‐occurrence of foetal type 2 signalling. Asthma, rhinitis and AD are manifestations of a common systemic immune imbalance (mesodermal origin) with specific patterns of remodelling (ectodermal or endodermal origin). This study proposes a new classification of IgE‐mediated allergic diseases that allows the definition of novel phenotypes to (i) better understand genetic and epigenetic mechanisms, (ii) better stratify allergic preschool children for prognosis and (iii) propose novel strategies of treatment and prevention.

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Section: Importance Of Type 2 Signalling In Inflammation and Remodellmentioning

confidence: 99%

Are allergic multimorbidities and IgE polysensitization associated with the persistence or re‐occurrence of foetal type 2 signalling? The MeDALL hypothesis

Bousquet

Antó

Wickman

et al. 2015

Allergy

105

125

View full text Add to dashboard Cite

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“…Eosinophils contain cytoplasmic granules that release cationic toxic proteins such as ECP upon stimulation. Mast cells are also involved in the complex pathogenesis of EoE and secret MCT upon stimulation (see Figure ) …”

Section: Introductionmentioning

confidence: 99%

Peripheral blood eosinophils and other non‐invasive biomarkers can monitor treatment response in eosinophilic oesophagitis

Schlag

Miehlke

Heiseke

et al. 2015

Aliment Pharmacol Ther

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Summary Background Monitoring of the treatment response in eosinophilic oesophagitis (EoE) requires structured endoscopical and histological examination of the oesophagus. Less invasive methods would be highly desirable. Aim To evaluate the utility of several EoE‐associated blood and serum markers in order to non‐invasively monitor the response to treatment with swallowed topical corticosteroids in adult EoE patients. Methods In a randomised, controlled double‐blind trial blood samples of EoE patients (n = 69) were collected at baseline and after 14 days of treatment with budesonide (n = 51) or placebo (n = 18) respectively. Absolute blood eosinophil count (AEC) as well as serum levels of CCL‐17, CCL‐18, CCL‐26, eosinophil‐cationic‐protein (ECP) and mast cell tryptase (MCT) were determined and correlated with oesophageal eosinophil density and with symptom and endoscopy scores. Results Histological remission, defined as mean number of <16 eos/mm2 hpf at end‐of‐treatment, was achieved in 98% of the budesonide and 0% of the placebo recipients. AEC [380.2 vs. 214.7/mm3 (P = 0.0001)], serum‐CCL‐17 [294.3 vs. 257.9 pg/mL (P = 0.0019)], ‐CCL‐26 [26.7 vs. 16.2 pg/mL (P = 0.0058)], ‐ECP [45.5 ± 44.7 vs. 27.5 ± 25.0 μg/L (P = 0.0016)] and ‐MCT [5.3 ± 2.9 vs. 4.5 ± 2.6 μg/L (P = 0.0019)] significantly decreased under budesonide but not under placebo. AEC significantly correlated with oesophageal eosinophil density before (r = 0.28, P = 0.0236) and after (r = 0.42, P = 0.0004) budesonide treatment. In ROC‐AUC analyses post‐treatment values of AEC were significantly associated with histological remission (ROC‐AUC 0.754; 95% CI: 0.617–0.891; P = 0.0003). Conclusions The budesonide‐induced treatment response in EoE is mirrored by several blood and serum markers, and the absolute blood eosinophil count is the most valuable as it shows correlation with the oesophageal eosinophil density.

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“…This response model was validated in a previous study that demonstrated that only T cell-deficient-not B cell-deficient-mice were unable to develop EoE. 22) In the past, it was believed that adult-onset disease was caused by aero-allergens, while childhood disease was mainly secondary to food allergies. 23) Currently, it is firmly established that food allergies play a major role in the development of EoE both in adults and children.…”

Section: Pathogenesismentioning

confidence: 78%

Eosinophilic Esophagitis in Adults: A Concise Overview of an Evolving Disease

2020

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Eosinophilic esophagitis (EoE) is a chronic inflammatory disease that encompasses esophageal symptoms along with eosinophilic infiltration of the esophageal epithelium. EoE is an evolving disease that has been a subject of interest to many researchers since the first studies recognized this condition as a new and distinct clinicopathological entity 25 years ago. Clinical presentation in adult patients may include dysphagia, food impaction, vomiting, and reflux symptoms. The diagnosis of EoE is based on the combination of clinical history suggestive of esophageal dysfunction, endoscopic features indicative of the disease, and histology revealing eosinophilic infiltration of the esophageal epithelium that persists after a trial of proton pump inhibitor therapy along with the exclusion of other disorders that may be associated with esophageal tissue eosinophilia. The interplay between EoE and gastroesophageal reflux disease (GERD) is complex, and differentiating these two conditions continues to be difficult and challenging in clinical practice. The mainstay treatment includes dietary modification, topical steroids, and/or endoscopic dilation. The primary care physician (PCP) plays an important role in improving patient care and quality of life by ensuring early referral and participating in management and follow-up. This article provides an overview of the current knowledge base regarding the disease including epidemiology, genetics, pathogenesis, common clinical presentations, the interplay between EoE and GERD, diagnostic approaches, and therapeutic options available to the PCP.

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Immunopathogenesis of Eosinophilic Esophagitis

Cited by 8 publications

References 31 publications

Are allergic multimorbidities and IgE polysensitization associated with the persistence or re‐occurrence of foetal type 2 signalling? The MeDALL hypothesis

Are allergic multimorbidities and IgE polysensitization associated with the persistence or re‐occurrence of foetal type 2 signalling? The MeDALL hypothesis

Peripheral blood eosinophils and other non‐invasive biomarkers can monitor treatment response in eosinophilic oesophagitis

Eosinophilic Esophagitis in Adults: A Concise Overview of an Evolving Disease

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